Wondering What to Practice at Home? Consider a Private Lesson

by Timothy

Door by Brad Gibson

In a recent post Home Practice: The Best Way to Improve Your Health and Well-Being, I wrote about the value of a regular home practice. Practicing at home is particularly important for people with a medical condition who can’t do (or at least probably shouldn’t be doing) most public classes. But medical condition or not, the question remains, which yoga practices should you be doing at home?

One of the best ways to find the answer is to get a private yoga lesson. As it turns out, yoga goes about prescribing home practice in a very different manner than doctors prescribe medications or other treatments. In western medicine, we always try to diagnose the condition first, and then give drugs or other treatments to address that problem. If we can’t diagnose the condition, then all we can do is give treatments to relieve the symptoms.

In yoga therapy, the western medical diagnosis certainly can influence the treatment, but it’s only one of the many factors we consider. Two women, for example, may have the same diagnosis of Stage 1 breast cancer, and would likely get very similar recommendations from their doctors about how to treat it. But the appropriate yoga approach (used as a complement to medical therapy) might vary a lot depending on how fit they are, how much yoga they’ve done (and what styles), how much time they have to dedicate to their practice, how spiritually oriented they are, and so on.

Good yoga teachers always consider the broader context. When I evaluate a student, after interviewing them, I often start out by looking at them structurally. How is their posture? Are their shoulders rounded? Is the head forward of the spine? Are they stiff or flexible? Are there certain joints that are giving them problems, and, if so, how well are the bones on either side of those joints aligned?

After structure, I tend to move onto the nervous system (and breath, since the two are intimately linked). Are they suffering from excessive stress? Agitated? Sleeping poorly? Can’t get out of bed? What’s the balance of the sympathetic nervous system (fight or flight) vs. the parasympathetic (rest and digest)? Is their breathing smooth and deep or is it shallow and choppy? Is it primarily in the upper chest or does the abdomen move out and in with each breath?

In a similar manner, I evaluate each student’s balance as seen through the lens of Ayurveda, India's indigenous holistic medical system, as well as their psychological functioning and such spiritual matters as their level of joy, compassion and fulfillment. In my Yoga as Medicine workshops, we divide our student assessments into five categories, using the acronym SNAPS: Structural, Nervous system, Ayurveda, Psychological, and Spiritual. Each student winds up with a different constellation of findings, which we then try to address with the yoga routines we recommend.

Although I developed the SNAPS protocol to use on people seeking yoga therapy, the same process can help determine a good routine for someone who is simply interested in using their yoga as preventive maintenance, to build strength and flexibility, or to work off some of life’s inevitable stressors.

Say a student looking for a home practice has a slumping posture, a restless mind, shallow upper chest breathing, and an increase in the Ayurvedic dosha of vata or air (see my post on vata, Autumn, Healthy Aging and the Ayurvedic Dosha Vata). If I considered only structure and breathing in developing her routine, I might think that focusing on backbends would be helpful. But too many backbends, or more intense ones, like full Wheel pose (Urdhva Dhanurasana), could increase her mental agitation and push her vata further out of whack.

Perhaps I would end up settling on some gentle, restorative backbends done over folded blankets to open her shoulders and chest, while simultaneously allowing her to rest physically and mentally. I might also recommend daily alternate nostril breathing to balance her nervous system, and quiet her mind to the point that seated meditation would be more effective. Often, we reach the final recommendations based on trial and error, for example, putting the student in a potentially helpful pose and seeing what it looks like and how it feels. Maybe we change the blankets a bit and look again or try a different pose entirely.

What I am describing is what a good yoga teacher or therapist would do in a private lesson. Not everyone can afford a private lesson (price varies based on the experience of the teacher, the length of the session and the geographical area), though some teachers have a sliding scale, or take on a few cases as karma yoga for those in need. But once you get home, yoga is free, of course, so a lesson could end being cheaper than a series of classes. (If you don’t know a suitable yoga teacher or therapist in your area, check out the database of the International Association of Yoga Therapists at iayt.org.)

Although science has yet to test the idea, it is my belief that a well-designed practice tailored just for you will likely be better than a standardized protocol used in a study or a sequence printed in a magazine. All those approaches, good as they may be, are determined without ever laying eyes on the student—and that’s simply not the best yoga has to offer.

To me, it’s a testament to the power of yoga that so many people are helped by these one-size-fits-all yoga fixes. However, to most of us working in the field, there is little doubt that a tailored approach can be safer, more efficient, and much more effective. As a scientist, I’m all for testing these notions, but yoga research hasn't progressed to the point where such studies are being done (or funded). In the meantime, my advice is, whenever possible, to tailor your practice now, and ask questions later.

Even if you don’t have a medical condition, working one on one with a teacher can help you create the home practice that suits your particular body, needs, and goals. And if such a tailored approach moves you more efficiently in the direction you’d like to go than an off-the-shelf routine, you’ll likely notice the benefits and be more motivated to stick with it. And that, of course, is the key to success in yoga.

Friday Q&A: Death of a Student

Q: I am a yoga teacher on the East Coast & have been teaching for 6 years. Last week, I found out a young student in one of my gym classes died (suicide, 2 weeks ago). He had been attending this class fairly regularly for the past 2+ years. The class is small, but it is not the type of environment where the students have developed close relationships with one another. They show up, practice & leave (it’s an evening class). We would have a few minutes before class to sit & wait for the earlier class to finish, but that’s the extent of any interaction that I’m aware of taking place.

I am struggling with whether or not I say anything to the group or let it go. He occasionally attended the class with a young woman, who it seemed he knew from outside of class, but I'm not sure how.

Any words of wisdom would be appreciated!

A: Firstly, let me express my sadness at your loss. Although I have not lost any students to suicide, I have had students who died suddenly, and found I was impacted by the loss more than I would have anticipated. Then, of course, there are two questions that seem to arise: Do I share this with the rest of the class? And, from a teaching perspective, how do I cultivate community in settings where it does not yet exist in a very tangible form?

I don’t think there is right answer to the first question, as many variables might influence the decision to tell the group of the death of a fellow student. But I, too, teach in a gym setting twice a week and have done so for almost 10 years now. I sometimes feel a lack of community there as well, although in reality, I have some students who regularly attend these classes, some for many years. Remembering this encourages me to speak with this group in the same way I do my studio students where community is perhaps more obvious. And every time I do share some difficult or personal information that has some relevance to our work together, I am invariably delighted with the feedback that I receive, and the interactions amongst the students that ensue. So, if you’d like a greater sense of community, situations like this and many others are perfect ways to get students connecting in ways beyond just their asana, pranayama and meditation practices.

One of my favorite sutras, which I have probably alluded to before, but which has some relevance here, is 1.33, where Patanjali gives some of the only guidance in his collection of sutras about how to behave and interact with one another. 

1.33. By cultivating friendliness towards happiness and compassion towards misery, gladness towards virtue and indifference towards vice, the mind becomes pure.

Here Patanjali suggests practicing compassion, karuna, when encountering suffering (misery in this translation), dukha. How one applies that, he does not say, but the reality of this loss to suicide, shared and discussed openly, may have the beneficial effect of making all of your students feel more connected, less lonely, and perhaps could conceivably prevent another such loss. All the best to you, your students and all of our readers this holiday season!

—Baxter

Keeping Your Sacrum and SI Joints Happy and Healthy

by Shari

Keeping His Sacrum Happy and Healthy

Now that I’ve described how the sacrum moves (see Yoga and the Sacrum), let’s look at how the sacrum and sacroiliac joints work in some of the typical yoga poses we encounter in a class, and how to keep your SI joint healthy and happy while you do them. Hopefully this will provide help for people who are already suffering from sacroiliac joint problems as well as for people who would like to avoid developing problems.

Note that if you think you might be having sacroiliac join problems but are not sure, I would recommend that you should not try to diagnose yourself. Instead, please try to consult a health care professional for a diagnosis. And although this injury is more common in women, it definitely occurs in men as well, so you guys should also get yourself checked out. Finally, for any of you pregnant yoga practitioners or teachers who teach pregnant women, all of these suggestions that follow are beneficial for pregnant women.

Now let’s get started at the beginning of a typical class. Warm ups are often asymmetrical because we work first with one leg and then the other. A typical warm-up series might include hip openers, reclined leg stretches (Supta Padangusthasana), Figure Four pose, and so on. Any type of hip opener that is asymmetrical will put different stresses on your SI joints. So for our Figure Four pose, when we stretch the piriformis on the right, the sacrum will be turned to the side that is being stretched, the right side. And conversely the sacrum will be turned to the left when we stretch the left piriformis. That’s all well and good, except if you have a piriformis that is already in spasm. Stretching it more only inflames that poor little muscle, so avoid this asymmetrical position if it hurts (or if starts to hurt while you’re in the pose, come out).

Leg stretches are also poses you may need to approach with care. If you are really tight, when you stretch your hamstrings, the hamstrings pull on your ischial tuberosities ( the sitting bones of the ilia), which flattens your lumbar spine and pulls your sacrum into a flexed position. This may cause you pain because as your sacrum is pulled down into the ilia, the two sides may not be moving equally (one side will be moving more than the other side).

When you take your leg out to the side and are stretching your adductors, try not to roll onto the SI joint of the raised leg and have the opposite side of the pelvis roll forward. Learn to move from your hip joint and limit the stress through your sacrum. If one side is tighter than the other, this may also create an asymmetry in the sacrum that will cause pain. In this case, less stretch is better (use a wall to stop the stretch on the raised leg, or use a block, chair, or bolster to limit the stretch).

For standing poses, if you are having SI problems, focus on symmetrical poses and using props. Also, be kind to yourself—think I am going to do 50% not 125%. Standing poses which are done with wide legs and an asymmetrical pelvis position may strain the ligaments holding the sacrum in place, which can then cause subsequent pain. Try firmly contracting the back leg to give some stability to the sides of the sacrum. Although Wide Legged Standing Forward Bend (Prasarita Padottanasana) is a symmetrical pose, how deep you go into the pose and what position your spine is in will all contribute different problems to the sacrum. So, when in doubt, try to keep your spinal curves in neutral and use a chair to take the torso’s weight and do less stretch than more.

In seated poses, spinal position is paramount. You want to keep your spinal curves in neutral and have enough height under your ischial tuberosities (sitting bones) to encourage your ilium to rotate over the femoral heads (hip joints). And never use your arms to pull yourself into pose, but instead rely on your abdominal muscles and spinal stabilizers. This applies to all practitioners, as both a preventative approach for those of you with no current problems as well as a therapeutic approach for those of your with SI problems. As Baxter mentioned, you want your sacrum to move with the ilia, not to be “held back.” If you are currently having symptoms, I would avoid revolved seated poses for quite a while until the symptoms are gone and you understand your vulnerabilities.

Backbends will either feel great or terrible, depending on your issues. Backbends and forward bends position the sacrum into very different positions. In forward bends the sacrum is less stable. In backbends the sacrum is more stable. But stability doesn’t mean it is going to feel good if the inherent alignment of the bones is not congruent.

If backbends feel good, pay attention to symmetry in how you go into and out of a pose. And be careful not to tuck the bottom of your spine—you lumbar spine needs to be in lordosis (curved) when you do backbends, which then puts the sacrum into a more optimum position. And less is better than more as you are healing.

However, if backbends feel terrible, don’t do them. Rather than putting a block under your sacrum in an easy Bridge pose, try an active Bridge pose and slowly evaluate how you feel afterwards. Less lifting is also crucial.

I hope this advice is helps you keep your sacrum happy and healthy!

Yoga and the Sacrum

by Shari

Nina asked me to expand a bit on Baxter’s previous post on sacroiliac challenges with asana practice (see Friday Q&A: Sacroiliac (SI) Joint Injuries). I wanted to start by giving a little more background on sacroilac anatomy. As Baxter previously stated, the sacrum is nestled in between the two ilia bones that comprise the pelvis. The front of the pelvis is the symphysis pubis and the back is where the sacrum is located.

The sacrum is affected by many different forces. Along with the pelvis, it forms the bridge between your head, spine, torso and arms with your legs and feet. All forces from the top of your body pass through your sacrum and out to your lower limbs, and at least sixty muscles directly or indirectly affect the sacrum.

However, the sacrum does not move on its own but moves only because of the connections it has to the two ilia bones as well as the muscles that either directly insert onto it or cross over it. This means that the sacrum can only be passively moved. The sacrum’s passive motions caused by muscle action directly onto the pelvis and coccyx (think pelvic floor muscles also) include pivoting (forward and backwards motion) and rocking (spinning on a certain axis).

When you go into a yoga pose, how you set your legs and pelvis up is going to directly affect forces on your sacrum. So if you are turning your pelvis to the right, unless your legs are in the same direction as your pelvis, your sacrum will get conflicting forces through it. There are too many muscles to go into in here, but it’s important to understand that the leg muscles that cross from your pelvis to your femur and the abdominal muscles that attach to your pelvis will have a profound affect on the position of your sacrum. The spine also has a direct effect of moving the sacrum, especially L5 (the lowest of the five lumbar vertebrae) as well as the two ilia bones.

Why the sacrum is so important for yoga students is that we put undue strain on the ligaments that are firmly holding the sacrum in place with the two ilia and on the ligaments that hold the sacrum to the L5 vertebra, particularly when doing asymmetrical poses. And one of the main muscles that has a direct affect on the sacrum is the pesky piriformis. Now why, of all the 66 muscles, am I singling out the piriformis? Well it is one muscle that many yoga students have heard about, and it is one of the main muscles that we stretch when we do Thread the Needle or Figure Four pose. The following figure shows the muscle in red (and you can see how it connects the sacrum and to the leg):

That's it for now! Tomorrow, we'll look at how the sacrum and sacroiliac joints work in some typical yoga poses (see Keeping Your Sacrum and SI Joints Happy and Healthy). Hopefully this will provide help for people who are already suffering from sacroiliac joint problems as well as for people who would like to avoid developing problems.

From Independence to True Longevity: More on Transferring and Yoga

by Baxter

The other day, I received an email from one of my teaching colleagues at the Niroga Institute’s Yoga Therapy program, Adi Shakti. Through her work at Stanford, she had come across the results of a new study that she thought, appropriately so, was a perfect promotion for the benefits of yoga. It turned out to be directly related to my post from last week about transferring (see "Transferring" and Yoga: Wisdom from Jane Fonda). In fact, while I merely suggested that yoga could improve your ability to transfer, and therefore allow you to be more independent as you age, this new study states that the ability to transfer (in this case, to sit and rise from the floor) actually has an influence on life expectancy. The study determined that the better your transfer ability, the greater your life expectancy:

“If a middle-aged or older man or woman can sit and rise from the floor using just one hand - or even better without the help of a hand - they are not only in the higher quartile of musculo-skeletal fitness but their survival prognosis is probably better than that of those unable to do so.”

One of the researchers, Dr Araújo, explained the close correlation between the test scores and survival as follows:

“It is well known that aerobic fitness is strongly related to survival, but our study also shows that maintaining high levels of body flexibility, muscle strength, power-to-body weight ratio and co-ordination are not only good for performing daily activities but have a favorable influence on life expectancy.”

This seemed so important than I decided to include the news release from the European Society of Cardiology here, almost in its entirety (see full news release here), as it is not very long and the statistical part is fairly straightforward. A few of my recommendations for yoga poses to help you sit and rise from the floor follow the news release.

“Ability to sit and rise from the floor is closely correlated with all-cause mortality risk: Test of musculo-skeletal fitness is 'strong predictor' of mortality in the middle-aged and older

A simple screening test of musculo-skeletal fitness has proved remarkably predictive of all-cause mortality in a study of more than 2000 middle-aged and older men and women.  The study, performed in Brazil by Dr Claudio Gil Araújo and colleagues at the Clinimex - Exercise Medicine Clinic in Rio de Janeiro, is reported today in the European Journal of Cardiovascular Prevention.(1,2)

The test was a simple assessment of the subjects' ability to sit and then rise unaided from the floor. The assessment was performed in 2002 adults of both sexes and with ages ranging from 51 to 80 years. The subjects were followed-up from the date of the baseline test until the date of death or 31 October 2011, a median follow-up of 6.3 years.

Before starting the test, they were told: "Without worrying about the speed of movement, try to sit and then to rise from the floor, using the minimum support that you believe is needed."

Each of the two basic movements [standing to sitting, and sitting to standing] were assessed and scored out of 5, with one point being subtracted from 5 for each support used (hand or knee, for example). Subjects were thus assessed by a composite score of 0 to 10. A [3 minute] film of the sitting-rising test can be seen at youtube.com.

Over the study period 159 subjects died, a mortality rate of 7.9%.  The majority of these deaths occurred in people with low test scores - indeed, only two of the deaths were in subjects who gained a composite score of 10.  Analysis found that survival in each of the four categories differed with high statistical significance. These differences persisted when results were controlled for age, gender and body mass index, suggesting that the sitting-rising test score is a significant predictor of all-cause mortality (emphasis mine); indeed, subjects in the lower score range (0-2) had a 5-6 times higher risk of death than those in the reference group (8-10).

Commenting on the results, the investigators said that a high score in the sitting-rising test might "reflect the capacity to successfully perform a wide range of activities of daily living, such as bending over to pick up a newspaper or a pair of glasses from under a table".  However, in this study a composite score below 8 (that is, requiring more than one hand or knee support to sit and rise from the floor in a stable way) were associated with 2 fold higher death rates over the 6.3-year study period. By contrast, scores in the range of 8 indicated a particularly low risk of death during the tracking period. "Even more relevant," reported the investigators, "is the fact that a 1-point increment in the [sitting-rising] score was related to a 21% reduction in mortality." They added that this is the first study to demonstrate the prognostic value of the sitting-rising test.

Offering an explanation for the close correlation between the test scores and survival, Dr Araújo said: "It is well known that aerobic fitness is strongly related to survival, but our study also shows that maintaining high levels of body flexibility, muscle strength, power-to-body weight ratio and co-ordination are not only good for performing daily activities but have a favorable influence on life expectancy.

"When compared to other approaches to functional testing," added Dr Araújo, "the sitting-rising test does not require specific equipment and is safe, easy to apply in a short time period (less than 2 minutes), and reliably scored. In our clinical practice, the test has been shown over the past ten years to be useful and practical for application to a large spectrum of populations, ranging from pediatric to geriatric."

Dr Araújo emphasized the great potential of the sitting-rising test among primary care physicians looking for a quick appraisal of musculo-skeletal fitness in clinical or industrial settings. "If a middle-aged or older man or woman can sit and rise from the floor using just one hand - or even better without the help of a hand - they are not only in the higher quartile of musculo-skeletal fitness but their survival prognosis is probably better than that of those unable to do so."”

Maybe the sitting-rising test has potential for yoga teachers looking for a quick appraisal as well!

Now for some practical suggestions on how asana practice can improve your score on the above test. In addition to the poses suggested last week, I’d add full or modified versions of Garland pose (Malasana) and Eagle Pose (Garudasana) for the legs. For core and back strengthening, Boat pose (Navasana), and Locust (Salabhasana) would be great choices. In addition to improving quad strength, strong hamstrings and calves are an important part of the equation, so Bridge pose (Setu Bandha) either practiced dynamically or statically, would do a nice job of strengthening these areas. I hope we will see a study done in the near future on yogis and non-yogis, age-matched, to see what their sit-stand scores would look like. I’m putting my money on the yogis! Go Team Longevity!

Bringing Yoga to Her Community: An Interview with Muriel Zimmerman

by Nina

Starting this blog with Brad and Baxter was the beginning of an adventure. Naturally we hoped there was an audience for our information on yoga and aging, but we didn’t think too much about who those people would be. Now, just over a year later, we find that we have readers not just all over our country, but also all over the world. And the information we’ve been providing has not only influenced the way people have been practicing and teaching but has inspired a couple of people to start yoga classes in their community. I have to say that hearing about new community classes  touched me more than just any of the other feedback we’ve received about our blog.

Recently I had the opportunity to meet one of those people, Muriel Zimmerman, in person, and when she shared with me some of the details about the yoga class she had started in her community, I just knew I had to interview her.

Nina: Can you tell us something about yourself and your job?

Muriel: I have been the Executive Director of the Children and Family Center of Northwest Missouri for ten years. The Children and Family Center of Northwest Missouri serves victims of domestic violence and sexual assault. We provided 4065 direct services (crisis management, case management, court advocacy, shelter, hot line and support groups) to 636 females, males and children this past year). Prior to that I was the Adult/Community Education Coordinator for the Maryville RII School District for eighteen years. For me, life is a balance between physical, emotional and spiritual. I’ve love all parts of my life—being a caregiver, patient advocate, work, being a parent, and facilitating support groups, teaching a variety of classes—while trying to balance taking care of myself.

I’d always been physically active, but hated to “exercise” and never seemed to find the time to take care of “me.” For eighteen years, work days often went from 8 a.m. until 10 p.m. with an hour break early evening to be home for dinner with the children. Being an emotional eater, meds from cancer treatments, hating cold weather and exercise resulted in a forty-pound weight gain. I have a library of self-help books, yoga tapes, etc. And I avidly believe in “lifelong learning.” I don’t even want to think about how many times I’ve journalled a “healthy me” program, involving keeping a daily food record, taking time for my spiritual journey, planning an exercise program, weighing myself. I’ve even taught nutrition classes. And when I haven’t felt successful, I’ve gradually given up.

But approximately seventeen years ago, I found a yoga teacher who taught classes one night a week. And I was “hooked” on yoga and all it had to offer. I was flexible and gradually found I was gaining more upper body strength, flexibility, and reducing stress. I found a good yoga routine and put it to music for a twenty-minute routine that I could do at home. I even have a chair yoga tape that shows movements for slow, medium, and advanced. But it sits on my shelf. Going to the gym and doing yoga in a class works for me. I think it has to do with the fact that I’m “missed” if I am not there, and I need some social interaction as one of the “vital needs” in my life.

Nina: What inspired you to start a yoga class?

Muriel: As an Adult Education Coordinator, I had the option to develop any community education classes for all ages I wanted to. A lot of my friends were complaining that they had no upper body strength, no balance or flexibility, fell often, were stressed, and problems they blamed on aging.  Their vocabulary focused on the words “could”, “should,” “would”, “but” or “if”.  WRONG.  I didn’t think this had to happen. I went to the Community Center and talked to staff about the number of individuals in the community who were “rehabbing,” needed or had knee replacements or hip replacements, or were overweight, had health issues, and other numerous “excuses” or “reasons” why they could not exercise. I knew from my previous health issues that those issues would only get worse. We had a choice: to have a quality life or not. We needed a safe, nurturing place to explore yoga with well-qualified instructors who would teach, monitor, explain and encourage us

Nina: What is the yoga class like?

Muriel: I think individuals are more apt to try something new if they know it will meet some basic need in their lives. Our chair yoga class is informal. It is currently taught on Wednesday and Fridays at 10:00-10:45 a.m., which is the same time and location that Senior Circuit Training is taught. That, itself, reduces stress for adults. There are lots of windows on the south side of the classroom. We sit with our backs to the window and the lights off, soft music, fans turned down and folding chairs with plenty of space between us. We are mostly older adults. We feel safe and nurtured in a small class (twelve maximum).

The instructor always tells us to do things at our own pace. At the beginning of each class she suggests that we might set our intention for the class: to breathe easily, to reduce stress, to strength, to become more flexible, to balance. This will be different on different days. What does our body tell us today? We are learning to be aware of our bodies.  She encourages us to put aside all the multitasking thoughts we have and focus on the moment, to be mindful and come back to our breath when our minds start to wander.

She always has a quote posted on a small white board at the front of the room stating the benefits of yoga or thought for the day.  She talks a lot about working with adults in nursing homes; as we do different stretches she tells us how that movement will benefit us (such as, the benefits of lying down flat on a bed to nap rather than sitting on our spine in a recliner chair with our feet propped up and our backs curved). She keeps reminding us to breathe easily. She always shows alternate movements and reminds us of small movements we can do at home.

We always start with a sitting routine. About half way through she will give us the option of doing the Warrior and other positions either sitting or standing behind the chair (using the chair for balance).  She tries to challenge us within our abilities. We always work on balance and strengthening and upper body and lower body movements. We find that some of these same movements are in the senior circuit classes, especially the relaxation movements at the end of class. It all works together. At the end of each class has enough time for relaxation that we all seem calm, relaxed, and peaceful. She always stays around for a few minutes after class so we can ask individual questions or comment on the class.

Nina: Is there anything else you’d like to tell our readers?

Muriel: We all have choices to a healthy lifestyle—how we spend our time, our talents and our money. We have our addictions (like chocolate, playing free cell on my laptop propped up in a recliner chair, etc.), our excuses, our priorities, our habits and routines. I just need to keep saying to myself, “don’t be judgmental or critical of myself and definitely not of others,” take it a step and a day at a time, determine what my vital needs are for a healthy life, and give myself a pat on the back when I take advantage of opportunities to improve my health.

The benefits of yoga for me? I’ve strengthened the muscles around the torn ligaments and my core. I no longer wear leg braces. My balance has improved. I’ve lost 25 pounds. I can “transfer” more easily (get out of bed and stand up straight without pain), go on walks without first thinking how far I might be able to walk and will I have the energy or strength to get back home. I’m finally starting to focus on “me” and feel I’m as important as anyone I care for.  I’m learning to understand my body, accept my strengths and weaknesses, keep a positive attitude and not feel guilty when I take time for yoga and myself. I feel more confident, have more energy, and definitely feel better about myself. I look forward to checking out this blog and learning how to age gracefully and enjoy each moment of my life. I just hope my story helps someone make the decision to explore the options of yoga and what life has to offer.

Muriel Zimmerman has always lived in the Midwest, and has worked as a teacher, Adult Education Coordinator, and is Executive Director of a domestic violence center, and active community volunteer. Her favorite pastimes are her perennial flower beds, spending time with family and friends, traveling, and being “Granma.” She is transitioning into retirement.

Yoga, Stress and Weight Management

by Nina

Are you planning to relax over the holidays? Because if you’re not and you are worried about gaining weight, perhaps you should set aside some time for yoga.

You see, I’m helping Baxter with research for his upcoming workshop on Yoga for Healthy Eating at the San Francisco Yoga Journal Conference in January and I’ve learned exactly how stress can induce weight gain. Of course, we all know about so-called “stress eating,” but I wanted to know why that happens (I’m like that, you know, always wanting to the whys and hows as well as the whats). And I found that it’s due to the combination of hormones that are released in our bodies when we’re under stress.

These hormones include  adrenalin, which gives us instant energy, along with corticotrophin releasing hormone (CRH) and cortisol. While high levels of adrenalin and CRH decrease your appetite at first—we usually don’t have much of an appetite during a crisis—the effects usually don’t last very long. That’s when the cortisol—whose job is to help you to replenish your body after the stress has passed—kicks in, increasing your appetite and driving you to eat more. And because most of us no longer expend extra calories while in the acute phase of stress (we’re no longer actually fighting or running when our “fight or flight” responses are triggered), we don’t really need to replenish our food stores. So the increased appetite results in, you guessed it, unwanted weight gain.

Chocolate-Almond Candy Heart Made and Photographed by Brad Gibson

In addition, while we’re under stress, we typically have an impulse to do something, to move. So unless you respond to your impulse to move with actual physical activity—yoga asana, anyone?—eating often becomes the activity that relieves the stress.

This is why both relaxation and exercise are recommended for reducing your appetite. When you use yoga or meditation to trigger the relaxation response (see Stress, Your Health, and Yoga), your parasympathetic nervous system reduces the levels stress hormones in your body. Exercise is also excellent for stress reduction as it, too, triggers the release of biochemicals that counter the negative effects of stress hormones. In addition, exercising will satisfy your impulse to move and hopefully prevent you from turning to food as a way to relieve your stress.

My prescription for preventing weight gain during the holidays? An active yoga practice followed by conscious relaxation (see The Relaxation Response and Yoga). And if you’re short on time, try even 10 or 15 minutes of conscious relaxation.

Yoga is a great thing but...

by Nina 

Stop Sign by Brad Gibson

“Yoga is a great thing but it is not everything or the only thing.”

That’s the sentence that popped into my mind while I was practicing yoga yesterday afternoon (a very enjoyable backbend practice, by the way). In the back of my mind, I was obviously mulling over a post I read on the It’s All Yoga Baby blog (see when the yoga doesn’t work: depression, failure & the purpose of practice), in which Roseanne talked about her depression and her feeling that she is “failing” at her yoga practice.

“Underneath it all, however, is a vague sense that I’m failing at my practice, that I’m as broken and fucked up as I was before I committed to yoga (chronic and clinical depression was what drove me to practice in the first place), that the practice isn’t working. There’s also the vague sense that I’m not allowed to be feeling this way – there are many stories of miraculous healing from depression (and everything else) through yoga, but nobody talks about the relapses. I feel like I’m doing something wrong.”

I’ve already mentioned in a couple of previous posts (see Practice As Many As You Can and Authentic Yoga) how reading Yoga Body by Mark Singleton brought home to me once again that most of what we consider to be “yoga” these days was developed in the 20th century. This means that, contrary to what some teachers claim, the yoga we know and practice these days is not some thousands-of-years-old practice that is the answer to everything, including depression and anxiety, as well as physical injuries and illnesses (though it can definitely help with those things for certain people). And I think those in the yoga community who promote it as such, do us all a disservice. Because the result for people like Roseanne is that when yoga doesn’t provide the answer for them, they feel as if they are at fault, that they are doing something wrong, or that they have “failed” in some way. And the truth is, yoga was probably only used to treat depression and anxiety starting in the 20th century.

When I teach yoga for emotional well-being (including depression, anxiety, stress, etc.), I always add that I while I consider yoga to be a powerful tool for improving mental health, it may not be the only answer for you. In fact, you may need to use it as a supplement to western medicine, including drugs and/or therapy. And I recommend that if you are in a crisis, you should consult with your family doctor or a mental health professional. You need to do whatever it takes to help you get better. And, please, no guilt or shame about this!

The truth is, many years ago, before I became serious about yoga but while I was taking regular classes, I had two nervous breakdowns (the diagnosis was agitated depression), within a five-year period. And I’m convinced that, especially during the second breakdown, that my family doctor and the drugs she prescribed for me prevented me from being hospitalized. Later on, life style changes, including a regular home yoga practice, helped me reduce the stress in my life that seemed to be the main trigger for my illness. And I’ve been well since then. But just as important, I believe that yoga has also helped me come to a state of self acceptance regarding my condition. And this included both overcoming my feeling of shame about taking medication for depression (my therapist encouraged me to stay on a low maintenance dose) and starting to talk—and write—about my experiences as a way of possibly helping others.

I want to be very clear that I’m not here giving any medical advice here. This post is not intended to tell anyone what the best way is to heal from depression. I just felt that it was very important to state that as wonderful as I feel yoga is, I believe it has its limits. And there's no shame in that. Really, all I’m trying to say here is summed up by the sentence that I opened this post with:

“Yoga is a great thing but it is not everything or the only thing.”

"Transferring" and Yoga: Wisdom from Jane Fonda

by Baxter

Nina recently shared with me some fascinating information about Jane Fonda, who has lived many lives, from actor to fitness guru to political activist, just to name a few.  Fonda reportedly used to practice a more strenuous yoga two hours a day. “But” she says now, “those days are long gone. It got to be too hard.” All of that hard work has paid off even as Fonda approaches her golden years, though. She puts it this way:

“Every single time I go to get out of a car now, I say ‘Thank you, Lord, I have strong quads. Because if I didn’t have strong quads, I couldn’t be independent. You have to keep your back and legs strong so you can remain free and independent.”

Truer words could not be spoken! In my years as a Family MD, I cared for a lot of seniors, seeing them in my office if they were still living independently, or making trips to the nursing home if they needed special care. And one of the key skills that often allowed my aging patients to remain at home, which is were they all preferred to be, was the ability to “transfer” independently. By this I mean that they could go, typically, from a sitting or reclining position, such as their bed, to a standing position without any assistance. And they had to be able to do the reverse, that is, safely transfer from standing to sitting. Obviously, if they could do this from the floor to standing or vice versa, they would be way ahead of most of their peers! I have a 75-year-old student who does just that each week in class with me.

I found this expended definition of “transfer” at the medical web site medicine.jrank.org:

“"Transferring" is the term used for moving from one condition to another, such as out of a bathtub, chair, or car, or getting into bed. The ability to transfer depends on many factors, including strength, balance, vision, and flexibility.”

Because of the physical benefits of a regular yoga practice, specifically maintaining flexibility, promoting muscular strength, improving balance and keeping the body agile, students who maintain a regular yoga practice are likely to remain independent much longer than their age-matched community, all other factors being equal. And even if they don’t have a vigorous practice like Jane did in her younger years, even a moderate or gentle yoga practice is likely to have the same four categorical benefits listed above.

Many of the standing poses would be likely to help with such daily activities such as getting in and out of the car.  Any standing pose that requires the knees to bend and straighten, such as entering, holding and exiting from Warrior 1 or 2, is simulating the action the knees, legs and hips perform for our car example (see Warrior 1 and Warrior 2 Mini Vinyasas). Even better would be Fierce pose (Utkatasana), also called Chair pose!, especially if you added in a twist. One of the more challenging transfers for older people is using the toilet in a standard bathroom. It is usually lower than a typical chair, and so presents more potential challenge for most. Yet, if you continue to practice in an intelligent, age-adjusted yoga class, such situations may be non-issues for the aging yoga practitioner.

In classes designed for seniors with no previous yoga experience, it is quite common to utilize chairs to modify many yoga poses. So, just by virtue of getting in and out the chair in class a few times in class, with mindfulness and attention to detail, the student is again performing a similar movement to other important daily activities. The stress-reducing practices of yoga, as well as the mental sharpening skills of dharana, or concentration practice, are also likely to improve our chances of remaining independent well into our later years. So, let’s follow Jane’s example and keep our body and mind strong and agile via a regular yoga practice, so that we won’t even need an extra thought as we push away from the dinner table, stand and move onto the next activity of our full and satisfying day! 

Practicing Yoga Mindfully

by Nina

Raindrops and Reflections by Nina Zolotow

Although it’s a rather new concept, approaching yoga poses as a mindfulness practice is a very powerful tool for improving your physical and mental health. Whether you are trying to change your eating habits, reduce your stress, or heal from disease, learning to listen to your body is crucial. In his wonderful book Full Catastrophe Living, Jon Kabat-Zinn points out what happens if we simply operate in automatic-pilot mode:

"One very important domain of our lives and experience that we tend to miss, ignore, abuse or lose control of as a result of being the automatic-pilot mode is our own body. We may be barely in touch with our body, unaware of how it is feeling most of the time. As a consequence we can be insensitive to how our body is being affected by the environment, by our actions, and even by our own thoughts and emotions. If we are unaware of these connections, we might easily feel that our body is out of control and we will have no idea why."

Kabat-Zinn goes on to say that physical symptoms are the messages your body is giving you that allow you to know how it is doing and what its needs are.

"When we are more in touch with our body as a result of paying attention to it systematically, we will be far more attuned to what it is telling us and better equipped to respond appropriately. Learning to listen to your own body is vital is improving your health and the quality of your life."

And one of the best ways to pay attention to your body systematically is to bring mindfulness into your asana practice. I, myself, have learned to recognize certain physical symptoms that tell me when I’m overstressed (for example, a burning feeling in my chest). When I experience those sensations, I know it’s time for me to scale back temporarily and practice the yoga poses that calm me down. In my interview with Elizabeth (see Meditation and Healthy Eating) about mindfulness and eating, she talked about learning, from both meditation and asana practice, to recognize when she was actually hungry versus thirsty or had low potassium and that has helped her lose and keep off 50 pounds.

So how you make your asana practice a mindfulness practice? Kabat-Zinn writes:

"We practice the yoga with the same attitude that we bring to sitting meditation or body scan. We do it without striving and without forcing. We practice accepting our body as we find it, in the present, from one moment to the next. While stretching or lifting or balancing, we learn to work at our limits, maintaining moment-to-moment awareness. We are patient with ourselves. As we carefully move up to our limits in a stretch, for instance, we practice breathing at that limit, dwelling in the creative space between not challenging the body at all and pushing it to far."

If that’s not enough—or if you have fallen into a rut with your practice that’s putting you in automatic-pilot mode, I have some specific suggestions:

1. Practice yoga at home. Practicing on your own, without the distraction of the teacher telling you what to do you or other people in the room, forces you to pay more attention to your own experience of being in the poses.
2. Pick a single physical sensation to follow throughout your entire practice, whether it is the quality of your breath in every single pose, the even distribution of weight on your feet—the balls as well as the heels—in every pose, or even something more arcane.
3. Change your routine. If you do practice at home and are in stuck in rut, try doing something different. Practice on the left side first instead of the right. How does that feel? Or, do all your twisting poses, even all the standing the poses, without turning your head. Twist from your spine only and leave your head looking down at the floor. Notice how hard that is, and how different your neck feels.
4. Try using props if you never have. See what difference it makes. Or, if you use props regularly, try a different height (lower or higher) or try practicing without props for once and see what a difference that makes.
5. Try holding poses for longer periods of time than you usually do. Notice the resistance that comes up in your body (as well as your mind).

Anyone who has additional suggestions, please chime in!

Friday Q&A: Sacroiliac (SI) Joint Injuries

Q: I have been having problems with low back pain caused by my sacroiliac joint (SI joint) going out of alignment. It seems like something I'm doing in my yoga practice is making it worse. I’m looking for both techniques to snap the sacrum and pelvis back into place and alignment, and advice on how to prevent this from happening. I would appreciate any help with this. I want to keep practicing!

A: I asked Baxter to answer this question because he’s the back care expert (and MD), but since I’ve had this problem myself, I know a little something about it. And maybe even have slightly different advice than Baxter. So Baxter asked me to preface his answer with my own.

First of all, this is a common injury for dancers and yoga practitioners, though not for the general population. In general, forward bends and twists take the sacroiliac (SI) joints out of alignment. Janu Sirsasana seems particularly bad. Backbends can put the joints back into proper alignment. So for now, I'll just suggest that at the end of a practice that includes forward bends and twists (even standing versions of these) that you include some kind of supported backbend before Savasana. Stay in the pose for at least three minutes. You want to restore the curve in your lower back. For example, Bridge pose with a block under the sacrum or even Legs Up the Wall pose with a bolster, where your lower back is arched over the bolster, can help restore the curve. (I’m recommending supported backbends because active backbends—which Baxter recommends below—at the end of a forward bend practice reverse the quieting effect of the practice. This is not really an issue for twisting practices. Regardless, you might try both as everyone is different.)

I also recommend that you read articles on the topic by Roger Cole on the Yoga Journal web site (see Protect the Sacroiliac Joints and Practice Tips for the SI Joints). I’ve learned a lot from him over the years, and have taken his workshop on the SI joint.

Finally, as wonderful as yoga is, it isn't necessarily the answer to everything, so you may need to take time off from certain poses or your asana practice entirely to heal before resuming practice. I, myself, as well as other yoga friends, have had good results from going to a chiropractor who realigns the sacrum manually. My chiropractor is also a yoga teacher—that's the perfect combination if you can find one. 

Now for Baxter’s reply.

—Nina

A: It might be helpful to our readers to define what we mean by “sacroiliac dysfunction.” Typically, the joint between your sacrum bone and the two halves of the pelvic bones meet at the right and left side of the posterior pelvic area and form a fairly firm, barely moveable joint called the sacro-iliac joint, or SI joint for short. 

The only exception to the “barely moveable” concept is for women about to give birth. In order for the safe delivery of the baby’s head and body, the joints of the pelvis, including the pubic symphysis in front, have to be able to move. The pregnant woman’s body produces a hormone, relaxin, which allows the ligaments around the joints to loosen and permit more movement than normal. Once the baby is safely delivered and breast feeding is concluded, the production and release of relaxin slows and disappears and the SI joint regains its previous firmness.

As Nina pointed out, seems there are a few groups of folks more likely to loosen one side of the joint. These include gymnasts, dancers and yoga practitioners. And indeed forward folds combined with twists seem to be regular culprits. These poses create a torquing action through the pelvis that can overstretch the ligaments and result in more mobility on one side. It is unusual, in my experience, to have someone with both SI joints hypermobile, but I have seen it at least once before.

And indeed, Roger Cole has written some very good articles on this topic, and leads workshops on the topic around the country, which I have attended and can highly recommend. In addition, Judith Lasater has an article in the Yoga Journal archives on her bout with SI joint dysfunction, how yoga brought it on, and how yoga helped her heal it (see Out of Joint).  She also has some discussion in her book, “Yoga Body” on the particulars as well, if you want to dive a little deeper. After reviewing the chapter in her book on the pelvis, I found a 1991 review of all the research to that date on intra-pelvic joint movement, including SI joint movement.  It seems there is some evidence for minor but distinct amounts of normal healthy movement at the SI joints, but a decent amount of confusion still existed at the time of that study.

As for asana recommendations, I like active backbends, especially Locust, but doing a variation Roger Cole teaches where you have the legs parallel, you strap the ankles and push out against the strap as you lift the legs up. He also recommends doing some asymmetric propping with sandbags, but I have found the symmetric version effective for some students.  And I’d put a block between the knees for active bridge and also consider strapping the thighs without a block and push out against the strap as you go up. I believe the theory is that you are creating some lateral space so that the SI joint that is misaligned can pop/slide back into place. These are only two of a whole slew of pose variations that Roger shares in his workshops, so look for the chance to study with him down the road.

And don’t discount the benefit of working with a good physical therapist, as I have had students who were taught some effective simple adjustments they could do to get the SI back in good alignment. And as Nina has mentioned, I have had some students work with chiropractors and osteopathic physicians who got adjustments that resulted in SI re-alignment.  Ideally, you would not need to do this very frequently.

This is certainly a hot topic, so keep your eyes and ears open for new developments on the issue of SI joint dysfunction.  Thanks for your question!

—Baxter

Featured Sequence: Travel Mini Sequence

by Nina

My chiropractor, Dr. Claire-Marie Holman, in Berkeley, California is also a yoga teacher. (I get adjustments for my scoliosis—for some conditions, yoga can only do so much.) As part of my self-care, Dr. Holman discusses my home practice with me, recommending certain poses for their therapeutic benefits. When I recently went in for a treatment, I was in between trips. So I asked Dr. Holman to recommend just a few poses for me to do while I was in the road, when I have less time to practice than I do when I’m home. She came up with a three-pose mini practice for me. I liked it so much that asked her if I could share it with my readers on this blog. She generously agreed.

So without further ado, here is Dr. Claire-Marie Holman’s travel mini sequence. The poses (and the thinking behind them) are the three she suggested for me. The order of the poses seemed obvious to me so I just went with my gut on that. And the timings are my suggestions.

1. Cat-Cow pose for six rounds.

This pose is an excellent warm-up for the second pose in the series, Downward-Facing Dog pose, and helps restore a back that might be sore from sleeping on strange beds (or different beds every night). So far, we’ve only featured the chair version of this pose (see Seated Cat-Cow Pose) on this blog. But, if you can, try the full version, with your hands and knees on the floor, and a blanket under your knees.

Start with your spine in a neutral position. Then, as in the chair version, on your inhalation, start moving from your pelvis, tipping your hips downward toward the floor. As you continue to inhale, gently lift your spine and lengthen into a gentle backbend. Lift your breastbone forward and up and allow your head and neck to lengthen out and back, coming into the Cow backbend.

As you exhale, start moving from your pelvis, releasing your pelvis in the opposite direction, moving the back of your waist upward toward the ceiling. As you continue to exhale, allow your middle back to move back as well and drop your chin toward your chest, coming into the Cat forward bend. Repeat for six rounds, moving with your breath.

2. Downward-Facing Dog pose for 30 seconds to 2 or 3 minutes.

This pose is one of best all-over stretches for shoulders, legs, and hips, which all get tight from the hours of sitting still required by traveling. As a bonus, you strengthen your shoulders, arms, and upper body while you’re at it. So far, we haven’t featured the full version of this pose, but John Schumacher has a good video of this on youtube.

If full Downward-Facing Dog pose is too challenging for you, try Half Downward-Facing Dog pose at the wall (see Half Dog Pose at the Wall) or the version with your hands on a chair seat (see Downward-Facing Dog (Chair Version).

3. Legs Up the Wall pose for 5 to 15 minutes. Come out if your legs fall asleep.

In addition to being a great anti-stress pose (who doesn’t get stressed out while traveling), this pose also stretches your hamstrings with gravity. And if you use a bolster or folded blankets or bathroom towels under your sacrum, with your tailbone off the support, this pose restores the curve to your lower back, providing an antidote to hours of seated positions. I can’t believe we haven’t featured this one yet, but we will soon, I promise.

We’re showing two versions of the pose today, one with just a folded blanket and the other using a bolster with a folded blanket underneath it and a second folded blanket under the spine. Try both versions to see which one is more comfortable for you. If they are equally comfortable, try the higher version, as this may enhance your relaxation. If this pose is uncomfortable for you, try Easy Inverted Pose (see Easy Inverted Pose).

Thanks so much, Claire-Marie! Readers, if you try this sequence, let me know what you think.

Knee Replacements and Yoga

by Shari

Nina asked me to add to Baxter’s previous post Arthritis of the Knee and Yoga about what the next step might be when your own self-care management techniques are not as effective and your quality of life is severely impacted. So I thought I would you give some background about the elective procedure total knee replacement and why you might elect to have it done. Professionally, I see a lot of total knee replacements in my work as a home health physical therapist, and I also have yoga students who come to my class either after the procedure or beforehand as they are preparing themselves for the surgery.

Although many people will never need surgery for arthritis of the knee, if you have severe joint damage, extreme pain that isn’t helped by other treatments, or very limited motion as a result of the condition, knee replacement surgery may be necessary. So if the arthritis pain in your knee worsens, and the exercise that once helped you feel better has become unbearable, your doctor may recommend a total knee replacement (TKR). Surgery for osteoarthritis can provide several benefits, including :

• improved movement
• pain relief
• improved joint alignment

When you research the procedure, you will discover there are gender-specific knees, which are knee replacement models designed for women, and dozens of other options, too, including different materials, sizes and models from a variety of manufacturers. How do you choose? Generally, you don’t. Surgeons typically determine which implant they’ll use when they are in the operating room and actually looking at the structure and size of your bones.

X-Rays of Knee Replacements (from Wikimedia)

Prior to surgery, however, you should have an informed conversation with the doctor about your options so you can ask good questions about why a particular model might be chosen, and determine if you’re comfortable with the doctor’s approach and experience or whether you’d like a second opinion.

When only a portion of your knee has severe arthritic wear and tear symptoms, as confirmed by diagnostic testing as well as subjective complaints, you may be recommended to undergo a “partial or unicompartmental knee replacement.” This may be recommended because it helps to straighten up the joint, which has changed its position as a result of osteoarthritis. Partial knee replacement can be more effective and durable if appropriate and are less invasive. Recovery time is less because there is less surgical trauma.When the entire knee joint is replaced that is called a total knee replacement, and the ends of the femur, top of the tibia and often the patella (knee cap) are fully replaced.

When you are ready to return to your yoga class, you should take time to talk with your teacher about your knee replacement. I will routinely ask these students a series of questions:

1.    How long ago was the surgery?
2.    Are you still in pain?
3.    Are you still in physical therapy?
4.    Do you have any hip or back pain (either before or after the knee replacement)?
5.    How much mobility do you currently have? Can you get up and down from the floor?
6.    Do you have arthritis in any other joints?

So be prepared to provide your teacher with this information. Knee range of motion will vary widely both in a recent post-operative knee as well as a knee replacement that is over one year old. A lot depends on how much motion you lost prior to the surgery and how hard you worked postoperatively. The answer to the question “Can you get up and down from the floor?” is important because it tells the teacher a lot about a student’s flexibility and strength. Knee flexion will vary considerably, but I have never seen a knee replacement with 155 degrees flexion nor have I ever seen someone able to do a deep squat. Whether this just happens to be my student demographic or not, I don’t know.

When resuming yoga practice, alignment is a big deal with knee replacements because post operatively you want to avoid torque forces through the joint because that affects cement in the joint. “Closed chain activities,” where your weight is shifted with your foot remaining on the floor,” where your foot is lifted off of the floor with subsequent weight bearing will affect the joint differently. For standing poses, I teach students with recent knee replacements to pick their feet up and then replace and position as opposed to pivoting to change directions. Down the road, you can introduce pivoting if it doesn’t cause pain or discomfort. Liberal usage of props; walls, chairs, blocks will assist the student in not over-doing too quickly.

Strengthening all of the muscles that cross the knee joint as well as secondary stabilizers is also important. This means front, back and side leg muscles. Attention to hip alignment and strength also translates to protection of the knee replacement. Kneeling is problematic but not necessarily injurious to the new knee. Finally, pay attention to the feet—where is the weight on the foot? A lot of individuals who suffer from arthritic hips and knees have feet that need some tender loving attention. Baxter in his prior posts talked about feet (see Your Feet on My Mind), and I agree that where the body meets the ground and how we stack up from there is crucial in protecting our joints for longevity, especially when we become bionic.

I would like to add that lot depends on your pre-surgical state of health. If you have been active up till the day of the surgery then your recovery time will take about three months till you feel like you have integrated the new knee into your body. This is a rough estimate, but it seems about right for a traditional total knee replacement. Minimally invasive and partial knee replacements have less trauma, so healing and function comes more quickly. For those individuals who have lost a lot of mobility and have developed severe range of motion loss and significant loss of muscle strength, the recovery time will be more arduous because of all the structural as well as cardiac changes.

Finally I want to emphasize this: talk to your surgeon before and after surgery to know what your particular limitations and precautions may be, and remember to share them with your yoga teacher. Remember this is an invasive surgical procedure and everyone heals in a different manner. Be kind to yourself and remember that with a lot of hard work you will regain function and improve the quality of your life. This the reason why you decided to undergo this surgical option in the first place.

Arthritis of the Shoulder and Yoga

by Baxter

If you have been following our blog for any amount of time, you’ve become familiar with the wide variety of joints and areas of our boney spine that can be affected by osteoarthritis. From your hands to your toes, any movable joint is subject to this condition of wear and tear on the end surfaces of the bones and their slick, cushiony covering, the cartilage. The older we get, the more likely we are to develop osteoarthritis somewhere in our bodies, including the shoulder area. Seems the magic age is sometime after 50, but if you have sustained a traumatic injury to your shoulder or have the rarer form of arthritis, rheumatoid arthritis (RA), you could develop the tell-tail symptoms of arthritis-pain, swelling and reduced movement at the shoulder.

I’ve worked with many students and patients over the years with arthritis, and I will mention that the shoulder area is less commonly affected than say the knees, hips or spine. But it does show up now and again. Turns out there are actually two joints in the lateral shoulder area that can develop arthritis.

The first one is where a finger-like projection of the shoulder blade or scapula meets the far end of your collarbone or clavicle at what is technically referred to as the acromioclavicular joint (the AC joint). You can actually feel to the top connection of this joint if you trace your collarbone from your breastbone toward your shoulder area. You’ll note a sudden drop off as you move laterally. That’s where the two bones meet. Arthritis in this joint usually refers pain to the front of the shoulder area.

Shoulder Joint from Gray's Anatomy

The second joint affected is where your arm bone, the humerus, meets the side of the scapula at something called the glenoid fossa (a shallow, cup-like area that is concave to fit the round end of the arm bone), forming the glenohumeral joint. Arthritis pain in this joint is usually referred to the back of the shoulder area. And like other forms of arthritis, a diagnosis is usually reached after a history and physical exam by your doc, possibly including X-rays to look for narrowing of the joint space or the development of bone spurs around the joint and, on rarer occasions, blood tests to rule out RA or drawing fluid from the joint to look for crystals or infection. Once diagnosed, usually with osteoarthritis, you’re likely to have rest, ice, anti-inflammatory meds and physical rherapy prescribed to help decrease swelling and pain, and increase your range of motion in the shoulder joints. On more rare occasions when these treatments are ineffective, injections or surgery may be recommended. Like the hip and knee joint, the surgeon may replace part of the joint with an artificial joint.

Humerous and Scapula from Gray's Anatomy

Where does yoga fit in? Well, since shoulder arthritis can result from chronic wear and tear action on the joints, it is possible that a yoga practice heavy on weight-bearing asana, such as Downward-Facing Dog pose, Push-Up pose, and arm balances, such as Crow or Heron, as well as vigorous repetitive practices that don’t vary much in their routine, could lead to this kind of shoulder problem. However, on average, yoga is more likely to be helpful as a tool for healing than the underlying cause of the problem. And if you suffer from shoulder arthritis, this is yet another setting in which working one-on-one with an experienced teacher could save you time in getting on the right course of practice to improving your symptoms.

Just as we discussed in arthritis of the hip, even with the abnormal changes to the joint that accompany arthritis, it is still essential to keep mobility in the affected joints. In the situation where symptoms are already present, you will want to proceed slowly and mindfully as you begin to experiment with yoga postures that are exclusively non-weight bearing (at least at first). Many of the standing poses, such as Triangle, Extended Side Angle (being cautious not to bear too much weight with the bottom arm for both of those), Warrior 1, 2 and 3 would all be reasonable choices.

Poses that involve more pressure around the shoulder joint, in which there are additional rotational forces, such as Prayer position behind the back, or Eagle arms, may not be appropriate, as they could more likely aggravate the joint than help it. However, working with a teacher, you may gradually be able to add in more complex arm movements if your symptoms stay quiet. Versions of poses you would be likely to encounter in class, such as the ubiquitous Downward-Facing Dog, may be added later if you are progressing, with wall versions, such as Half Downward-Facing Dog at the Wall (see here).  And since it is not unusual for the muscles around the affected joint to be atrophied from lack of use when the joint is initially inflamed, holding the arm positions, like Warrior 2 arms, for 30-60 seconds can add strengthening of the muscles to the goal of maintaining mobility in the joint.

In addition, the pain-diminishing effects of pranayama and meditation practices could be very helpful along with your physical poses, and could be substituted for asana during times when your shoulder symptoms flare up and resting your body makes more sense for a while.  And, as always, we welcome your comments and experiences with the topics we share with you. So if you have some yoga insights on arthritis of the shoulders, we are all ears (and shoulders, of course!).  

Practice As Many As You Can: T. Krishnamacharya's Yoga

T. Krishnamachrya in a "New" Pose

by Nina

In my post last week Authentic Yoga, I mentioned that most of the yoga asana we do these days were invented in the early 20th century. In his book on the origins of modern posture practice Yoga Body, Mark Singleton focuses in particular on the innovations of T. Krishnamacharya, the teacher of three very influential 20th century yoga teachers who had a tremendous impact on yoga in the western word, Iyengar, Jois, and Desikachar. Krishnamacharya was clearly a genius, whose system, as Singleton puts it:

"can be fruitfully considered a synthetic revival of indigenous exercise (comprising yogasana alongside other types) within the context of Westernized curricular physical education in late colonial India."

Because so many people are reluctant to practice yoga at home due to concerns that they might not be doing it “right” or don’t have time to do what they would do in one of their full-length classes, it’s worth taking a little time to look at what Krishnamacharya (who was, for many of us, the original teacher of our teacher, or our teacher’s teacher) was doing in the late 19th and early 20th centuries. Dear readers, he was making stuff up! For details you can see the wonderful book The Yoga Tradition of the Mysore Palace by N.E. Sjoman. But for now let’s just look at this quote in Yoga Body from T.R.S. Sharma, one of a group of students at the yogasala in Mysyore, which confirms that Krishnamacharya’s teaching was intended to be, and in practice was, experimental:

"was innovating all the time in response to his students. He would make up variations of the postures when he saw that some of his students could do them easily. “Try this, putting this here, and here.” He was inventing and innovating. Krishnmachrya never emphasized a particular order of poses, there was nothing sacrosanct about observing order with him. He would tell me “practice as many as you can.”

The quote as whole really brings home the idea that, regardless of what we may have been told by certain teachers, the practice of yoga asana traditionally was not a rigid system that you have to follow or else it won’t be effective. And it seems to me, if you’ve been reluctant to practice at home due to time restrictions or concerns about doing something wrong, this quote contains a great motto for home practice in general:

Practice as many as you can.

Since it is December already and you may be thinking about New Year’s resolutions, “practice as many as you can” also seems like an excellent resolution for starting or deepening a home practice next year.

P.S. Hey, Krishnamacharya's alignment in Utthita Parsvokasana (Extended Side Angle pose) in the photo above doesn't look the same as what I've been taught is "correct," so that must mean....

Friday Q&A: Marijuana and Yoga

Q: With the legalization of marijuana in the news I thought it would be a good time to bring up the question of marijuana use during yoga practice. I find that if I smoke after work that I suddenly become much more aware of my body and that I am more motivated to do poses to counteract what my body has gone through throughout my working day (I am a housekeeper). Also, when I want to commit to a good lengthy home-practice session, using marijuana has facilitated holding my intention that I set before practice throughout the entire practice, and has ultimately aided in making breakthroughs in my yoga practice. I don't like to smoke everyday in my personal life, nor every time that I do yoga. What are the ramifications for an older person who uses marijuana? Are there opinions in the yoga community regarding spiritual and physical ramifications of marijuana use?

I am not looking for a reason or an excuse to use marijuana. I am simply trying to gather informed opinions on its pluses and/or minuses and make appropriate choices for my future.

A: Baxter and I wondered whether we should even answer this question—it seemed somewhat controversial—but here we are on a Friday and this is the only question that came in this week, so what the heck. So we talked it over in person, and Baxter said that he does not really have any knowledge or expertise in this matter (and he’s the yoga teacher/doctor). He suggested that as there is a lot of scientific information about the long-term use of marijuana—apart from the yoga practice issue—you should search out that information on your own to answer your question about the ramifications for an older person who uses marijuana.

As far as the yoga community goes, I know you can find modern yoga teachers in both camps, some for and some against the use of marijuana or other mind-altering drugs during practice. I’ve certainly known both types, myself (my lips are sealed!). In a way it might depend on why you’re practicing yoga. If you are practicing to quiet the “fluctuations of the mind,” which is how the Yoga Sutras defines “yoga,” then using a mind-altering substance would seem counterproductive. In fact, for the ancient yogis, purity of the body was a very important aspect of achieving enlightenment. (Original hatha yoga included a great many cleansing practices, such as shoving a strip of cloth down your—oh, never mind.) However, if you’re practicing yoga asana as a form of exercise, maybe this is not such an issue. My one concern is that it is possible that practicing while you are high might cause you to be less mindful and injure yourself—for example, would you practice drunk?—but I have no proof of that. Mainly, to be honest, your question reminds me of the questions in the New York Times “The Ethicist” column. People usually write in to The Ethicist when they have qualms about something.

If anyone else wants to weigh on it this issue, please do! Baxter says he hopes you will.

—Nina